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Bofutsushosan (BTS), one of many traditional Japanese medicines (Kampo medicines) is attracting attention for obesity and metabolic syndrome. We report allergic cystitis caused by 8-year BTS usage in a 70-year-old female. The patient presented with micturition pain with sterile pyuria over a 3-month period. Cystoscopy showed diffuse urothelial erythema and edema. Urine cytology specimens showed increased eosinophilic cells. By discontinuing BTS, the cystitis symptoms disappeared after 4 days, and urinalysis normalized. Resuming BTS without physician approval resulted in cystitis symptoms and after cessation the symptoms rapidly subsided. This is the first English case report linking allergic cystitis to herbal medicine.

Introduction This paper presents the “Central Road” cystoscopic finding accompanied by magnified mixed urinary incontinence following laparoscopic sacrocolopopexy. Case presentation A 70‐year‐old female experienced severe mixed urinary incontinence upon completing laparoscopic sacrocolopopexy. The cystoscopy showed a cord‐like appearance in the center of the bladder trigon and posterior wall. Videourodynamics confirmed stress urinary incontinence, and chain cystourethrography indicated that the proximal urethra was open and the posterior vesicourethral angle was atypically widened. After implanting a midurethral sling, mixed urinary incontinence was cured subjectively and objectively without medication. Conclusion The “Central Road” cystoscopic finding can be a signpost pointing to laparoscopic sacrocolopopexy mesh overtensioning, which can cause dekinking of the bladder neck, exacerbate stress urinary incontinence, and possibly lead to stress‐induced instability. A midurethral sling successfully relieved mixed urinary incontinence in this case, but it might be necessary to loosen the laparoscopic sacrocolopopexy mesh in some other cases.

Objectives: To evaluate the predictive value of growth patterns in patients undergoing sorafenib treatment for metastatic clear cell renal cell carcinomas (CCRCCs). Methods: Forty-eight patients were analyzed, each of whom underwent nephrectomy and received sorafenib treatment for metastatic CCRCC. Progression-free survival (PFS) was predicted using pathologic parameters, including pathologic stage, Fuhrman nuclear grade (FNG), the presence of a sarcomatoid component, lymphovascular invasion, tumor necrosis, and growth pattern. Results: Three (6%) patients showed partial response, 20 (42%) patients showed stable disease, and 25 (52%) patients showed progressive disease. Univariate analyses demonstrated that FNG, the presence of a sarcomatoid component, tumor necrosis, and growth pattern were significantly associated with PFS. In the multivariate analysis, growth pattern was the only parameter that was significantly and independently predictive of PFS. Conclusions: As a novel histologic prognostic parameter, growth pattern may be useful for predicting response to sorafenib treatment. [ABSTRACT FROM AUTHOR]

Objectives: To assess the validity of growth pattern as a unique prognostic parameter for clear cell renal cell carcinoma (ccRCC). Methods: In total, 561 patients with pathologic tumor stage 1 (pT1), pT2, and pT3a ccRCC without preoperative metastasis were evaluated. Clinicopathologic parameters, including pathologic tumor stage, Fuhrman grade, tumor necrosis, lymphovascular invasion, and growth pattern, were analyzed to predict disease-free survival (DFS) and cancer-specific survival (CSS). Results: Growth patterns were defined as follows: expansive included tumors with well-circumscribed margins without normal renal tissue in the tumor, and infiltrative involved tumors with ill-circumscribed margins or normal renal tissue in the tumors. In multivariate analysis, Fuhrman grade, tumor necrosis, and growth pattern were useful predictors of DFS, whereas Fuhrman grade and growth pattern were useful predictors of CSS, although only 30 cases showed the infiltrative pattern. Conclusions: Growth pattern can be considered a new prognostic parameter for ccRCC. [ABSTRACT FROM AUTHOR]

AbstractObjectives:We retrospectively reviewed the clinical outcome and long-term cancer control of patients with localized large renal-cell carcinomas (RCCs) who underwent laparoscopic radical nephrectomy in comparison to open procedure.Patients and Methods:One hundred and thirty-one patients with RCCs greater than 7 cm who underwent radical nephrectomy between 1996 and 2008 were studied: 52 patients in the laparoscopy group and 79 in the open group. In this analysis patients who had metastasis or pT4 disease or tumor thrombus in the inferior vena cava were excluded. The median follow-up period was 41 months in the laparoscopy group and 51 months in the open group.Results:Patients in the laparoscopy group had tumors similar in size to those in the open group (88 and 89 mm, respectively), lesser blood loss (245 and 663 mL p< 0.01), but more intraoperative complications (15% and 2.5%). One laparoscopy patient was converted to open surgery because of an injury to the inferior vena cava (IVC). The 5- and 10-year disease-free rates and patient-survival rates were comparable in both groups.Conclusions:Laparoscopic nephrectomy is feasible for localized large RCC, although intraoperative complications were more frequent. No statistically significant differences were found in either disease-free or cause-specific patient survival rates between the laparoscopy and the open groups. Laparoscopic nephrectomy can be an alternative to the open procedure for localized large RCC. However, a longer follow-up period is necessary to confirm the oncological efficacy of this procedure. [ABSTRACT FROM AUTHOR]

Upper-pole apical renal tumors are difficult to see using conventional rigid laparoscopes during laparoscopic partial nephrectomy. Added to this, the instrument angle makes tumor excision and kidney reconstruction difficult. We therefore elevated the kidney using a gauze sling and observed the lesion through a flexible laparoscope. With a clear field of vision, we could excise tumors and repair the kidney more easily. [ABSTRACT FROM AUTHOR]

Purpose We report on two cases of laparoscopic bilateral nephrectomy for renal-cell carcinoma (RCC) in patients with end-stage renal disease.Patients and Methods Bilateral renal masses were detected in two patients with acquired renal cystic disease. They underwent bilateral laparoscopic nephrectomy. The specimens were removed intact via an umbilical incision.Results The operative times were 8 hours and 6 hours and the estimated blood loss was 154 mL and 120 mL. Both patients resumed oral intake on postoperative day 1 and were discharged on postoperative day 6. No intraoperative and postoperative complications occurred. The pathology report revealed bilateral RCC. The original length of the umbilical incision was 4 cm which shrank to 3 cm by 2 months after the operation.Conclusions Bilateral laparoscopic radical nephrectomy including intact organ retrieval for bilateral renal masses via a small umbilical incision is feasible. [ABSTRACT FROM AUTHOR]